_______________
Board-Certified in Pain Managment
CLAIMANT NAME:
EXAMINER:
ECN #:
CLAIM #:
DATE OF LOSS: 08/17/2021
DATE OF SERVICE: 04/23/2024
Peer Review
This is a peer review regarding ___________. I have been asked to review the medical records on behalf of ECN. I reviewed records from 03/06/2020 through 03/06/2024 including:
Sloane Chu, MD / Diagnostic Radiology, on 03/06/2020
Bahnam Thomas, DO / Occupational Medicine, on 09/13/2022
Reich Phillip, MD / Diagnostic Radiology, on 09/24/2022
Li Sean, MD / Pain Management, extending from 11/16/2020 to 02/10/2021
Elizabeth Dewart, NP / Nurse Practitioner, extending from 11/19/2020 to 03/01/2021
Rechnic Mark, MD / Plastic & Reconstructive Surgery, on 02/11/2021
Deutsch Eliana J., NP / Nurse Practitioner, on 03/12/2021
Sarah Murray, PhD / Clinical Genomics, on 04/14/2021
Lacoursiere Daphne Yvette, MD / Obstetrics & Gynecology, extending from 04/06/2021 to 11/30/2021
Hull Andrew Dean, MD / Maternal & Fetal Medicine, on 04/16/2021
Dr. Sophia Chang, on 05/13/2021
Ballas Jerasimos, MD / Obstetrics & Gynecology, on 06/09/2021
Electronic Interface To Epic, Softlab Lab Results on 07/15/2021
Cowles Keri Malament, MD / Obstetrics & Gynecology, on 07/15/2021
Koenig Jenny Byrne, MD / Psychiatry, on 08/05/2021
Woelkers Douglas A., MD / Obstetrics & Gynecology, on 09/29/2021
Ottum Payton Amelia, MD / Obstetrics & Gynecology, on 10/08/2021
Macaulay Kathryn Marie, MD / on 10/09/2021
Koenig Jenny Bryne, MD / Obstetrics & Gynecology, on 10/14/2021
Thomson Samantha L., MD / Obstetrics & Gynecology, on 10/18/2021
Lan Quach, PA / Physician Assistant, extending from 11/10/2021 to 03/03/2022
Dean Riley Anderson, MD / Plastic Surgeon, on 03/16/2022
Dobke Marek Krzysztof, MD / Cosmetic & Plastic Surgery, on 03/17/2022
Dawn L. Marthis, OTR/L / Occupational Therapist, extending from 06/15/2022 to 07/20/2022
Jerry Bobo, MD / Psychiatry, extending from 04/26/2022 to 07/13/2023
Iftikhar Rafa, MD / Pulmonologist, on 05/22/2023
Gross Erin Andrea, MD / Obstetrics & Gynecology, on 06/04/2023
Scott K. Tanaka, MD / Orthopedic Surgery, extending from 01/13/2021 to 06/29/2023
Irix, on 07/26/2023
Kristine C. Flores, MPT / Master Physical Therapist, extending from 10/24/2023 to 02/02/2024
Shane Giblin, PTA / Physical Therapist Assistant, extending from 10/24/2023 to 02/22/2024
Francesca Barton, MSPT / Master Physical Therapist, extending from 10/26/2023 to 02/22/2024
Michael Quinn, DPM / Podiatry, extending from 01/13/2021 to 03/06/2024
Jirael Hipol, DPT / Deputy Physical Therapist, extending from 10/18/2023 to 03/06/2024
DIAGNOSES:
Pain in right foot, metatarsalgia; CTS s/p release 5/10/2022; Right foot surgery 7/11/2023, Employee reports right foot procedure on 4/9/2024.
RESPONSE TO QUESTIONS:
1. Please provide your assessment of restrictions and limitations as of 02/13/2024 to present. Please consider self-reported symptoms, fatigue, any cognitive issues, or medication side effects, and the cumulative effect of these. Please explain your medical rationale.
2. Please advise if the claimant`s abilities are sustainable 40 hours per week on a reliable and consistent basis 02/13/2024 to present, or for what specific period or interval. If limited endurance is a factor, please explain what findings support this.
3. Please explain the medical rationale for your opinion. Please comment on the Attending Physician`s opinion of functionality, and any differences with your opinion.
4. If in your opinion limitations in work function are substantiated, please comment on the expected prognosis for improvement.
Sincerely,